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Walkoffshot last won the day on June 26 2018

Walkoffshot had the most liked content!


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    Physician Assistant

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  1. Wait, I’m confused. The point of this post is to discuss why PA’s aren’t assistants... instead it turned into a pissing match between ArmyPA and why surgical PAs are the true “assistant”. Whose team are you on? I’m sure there are a lot of PAs in UC or EM that need the guidance of the doc, just as there are a lot of surgical PAs who can practice autonomously until surgery is necessary; thus requiring input from the surgeon. If I were a patient, I would hope my surgeon would at least see me once before cutting me open. If you think practicing without autonomy = assisting, then there would be several examples in ANY field of medicine of PAs “assisting”. Regarding your N=1 case presentation in your initial post about the discussion you had with the surgical PA. That’s all it is... 1 encounter. Please don’t overgeneralize.
  2. My first job I left in 5 months. The doc is notorious for making the PA a glorified MA. On the last day I sat down with my SP and outright told him that he would be better off hiring an extra MA to do the job I was doing. He actually appreciated the feedback. Didn’t learn though... word on the street he has had 3 new PAs since I left 3 years ago. I said what had to be said though.
  3. What is your current term set at? 10 years? If you continue down your $200/month path then you will have paid that loan off faster than the original term (if set at 10 years). Once finished then you have your regular payment + $200 you can now put towards investment instead of the loan... which you would then have to do the math see how long it would take to get to your projected 82,500 going that route. For example, if you pay your loan off in 7 instead of 10 years, you have 36 months of cash money going to investment. If your monthly loan payment is 1200 + add'l 200 = 1400 x 36 = 54000 (or 16,800 per year).. add on said 11.9% return. With a 11.9% return it would take you more than 3 years to reach 82,500, but I also think 11.9% is kind of a stretch and many factors involved. I think it also comes down to what do you want the most... 10 years of payments (plus investment) or financial freedom sooner. Only you can answer that. I just paid off my loans and i'll tell you a little secret... it's freakin glorious.
  4. We actually would save and throw down a lump sum, probably every 6 months. Not the most ideal way in terms of optimizing interest, don't know forsure on that (although the money that was saved was invested), but it worked for us. We sort of had intentions of paying off some and then getting into a home after the loans were more manageable, but finally we decided to pull the trigger, which resulted in lump sum payments. We don't really have many other expenses. I have a $200 car payment, wife's car is paid off but is junk (but i tell her its great ?). No kids. Our rent is $1200 for a 900 sq ft apt. Standard utilities, phone, cable etc. Our current savings rate is roughly 40-50% of net pay (our gross last year was roughly $180k together). Frankly, our savings rate should be higher, but we like to spend a little bit. We don't make sacrifices to our food, tend to eat healthy, lots of organic food etc which is not always cheap. Above all else, our biggest sacrifice is not buying a home. That has been a constant struggle for me, because I very much dislike the apartment life. Like i said above, everyones situation is different... without many expenses we are in a great position to do this. Part of it is also accepting it as a challenge and staying committed to it... it gets pretty hard sending that money away without seeing the immediate benefits other than financial (student loan) freedom.
  5. Just wanted to share my experience in case anyone is thinking about taking the plunge... As of today, no more student loans for me. I graduated in 2014, have been in practice for a little over 3 years now. Started out with roughly 120k in student loans, government and private. Have really just focused on paying the loans down for the last 2 years. My wife and I live in a smallish apartment and have been fairly good with our budget. Once we decided to tackle the loans we remained committed to make it happen. We obviously do not own a home but we are okay with this. I have been able to contribute to my employer matched 401k, nearly maxing out since I was eligible, while also maxing out my wife's IRA (doesn't have employer 401k). Every once in a while I see a topic on here about paying off student loans vs investing vs buying a home. Obviously, everyone's situation is different, but I will say it feels pretty damn good to have this weight lifted. It's definitely not easy, and I have to thank my wife for her support as we have avoided buying a home that we both want, and even put off having kids (until said home is purchased). In the end I have a strong opinion that it will pay off. Truthfully, I was kind of hoping that the housing market crashes during this time we have been saving to pay off these loans and we could jump in at the right time. Don't foresee this happening, but you never know. What I have come to realize is that renting is not all that bad. If we were to buy a home in our current market, a mortgage on a ~350-400k home would mean an interest payment probably around what we are paying for rent anyways. Spend less on a home and we would be blowing cash on repairs for a fixer upper. Just my opinion, but I feel like it is a wash and I would rather have the extra cash to save for loans then pay principle on a house. Now, with all the extra cash in our pockets we could make extra payments on a mortgage and pay off sooner.. maybe.
  6. I see your point, however, we could control our own schedule as we control who we work with and control when we work. Yes, the surgeon has their own schedule but I personally could control if I work with them on specific days/time. I can't argue the "supplying the tools" part. I assume this would include things such as closure material (suture, needle driver etc.) and retractors among others. That's the challenge. I'm curious, does anyone know if creating an LLC would allow us to avoid these restrictions? There has to be a way... again, I know of several first assist businesses (owned by RNFA's) that function... unless they haven't been audited yet..
  7. Does this still apply for surgical assist fees? Is there a difference between the clinical vs the surgical side of contract work and billing? I know of several groups that have created a contract first assist business... but mostly made up of RNFAs.
  8. Curious.. was a gram stain performed? (I assume it was). That can dramatically change how you treat with abx and can somewhat help clear the mud. Hopefully C&S was done as well... final result would be in by now. Any updates? I wouldn't say the cell count itself is impressive for infection but those PMN's are freakin high. At 91% PMN's you have to assume infectious. Maybe contamination... but the patient presents infected. I get fluid reads as "cloudy" that aren't infectious. Could be cloudy because of debris, inflammatory conditions (outside of infection) etc. That said, you would think if this guys knee has been infected there would be frank purulence which is obvious. edit: read again, looks like you mentioned no organisms seen.. assuming thats from the gram stain.
  9. Completely anecdotal but we have seen/treated 2 Achilles tendon ruptures in the last year in our Ortho practice that we repaired in otherwise healthy young (30-40 y/o) males with a recent history of fluoroquinolone use. One was from playing basketball and another was from a direct injury to the Achilles. Can’t say forsure it was from the quinolone but likely was a contributor. We have treated a handful of patient with Achilles tendinitis, cuff tendinitis, epicondylitis with recent quinolone use as well. Our standard practice is advising the patient to avoid ballistic activities for a period of time (dependent on initiation of quinolone and symptom onset). Agree with above that the risks should be layed out clearly and ballistic activities should be avoided. Obviously try an alternative abx if possible. In my opinion if the patient needs it then they need it but should understand the risks and how to avoid injury.
  10. On the flip side... it's also a tough pill to swallow forking over $1200 in loans each month for 10 years or more, and then trying to max out a retirement fund. Im sure not many people can do that comfortably. Add in a mortgage which can be a lot or little depending on location. Add kids in the mix and good luck. Im sure there are some out there that can/are doing this but I'm sure its not common.. maybe I'm wrong. Now take that $14,400 that you dump into loans each year for just minimum payment, add the $12,500 for the remainder of the 401k (employer match of 3% at 100k salary plus your match minus 18,500) which would equal roughly 27k. Put that towards student loans and your paid off in 4 years if loan amount is 100-110k. Then you can fund the retirement AND put 14,400/year into a personal investment account for the rest of your life (something you couldn't do if you were trying to max out retirement AND pay your loans of for the standard/max term AND mortgage etc). I don't know the numbers but I would imagine the compound interest of 14,400/year for the 6+ years you don't have to pay off those pesky loans is not far off your projected numbers if you were to just max out retirement. OR don't invest in a personal account and you have 14,400/year for anything you want to spend it towards. THAT to me sounds less stressful, but that's my opinion. (EDIT... OOPS.. I didn't read your last paragraph until I wrote this and you basically said just that.. good point!) Speaking from experience, I am doing what I stated above.. but have managed to pay off my loans in about 2.5 years (~120k.. have 20k left that we are about to finish off). That's just from me and my wife.. no help from anyone. I make above average for location/speciality.. wife makes decent money (about 1/2 my salary).
  11. It should. Guess it depends on your FP situation/location. If I saw this in our ortho clinic we have a hand doc to expedite (ie, direct admit to OR), but I work in ortho so a bit different.
  12. textbook tenosynovitis any sign of puncture wound, abrasion, nail biting etc? X-rays to rule out other source although unlikely (gout, arth). Presumably it is infectious. Refer to hand specialist like now. I assume based on your post about "providers in another location" that you did do this?
  13. Would like to add on the student loan discussion with my experience/situation... After months of pondering this "Do I pay off loans, invest, or buy a home?", I/we decided to work towards paying off loans. I have been in practice for almost 3 years now. I really just started focusing on my loans in the last year. My wife and I started with a budget, set aside an emergency fund, and put our savings/income into an personal investment account to build until we were able to pay a lump sum on the loans. Since December we have paid off $50k (private loan) and hopefully have my gov't loan (another $50k) paid off by summer of next year. We are very fortunate to have two decent incomes... which certainly helps. We rent an apartment in a metro city (ain't cheap) but I also believe that given our situation renting is > than buying a house. After trying to find a home in our area, without having a massive commute, we calculated that the interest on a mortgage payment is close to the same as our rent payment. Seems silly. Then take into consideration a down payment, property tax etc, home repairs/updates and we would be in this never ending battle of allocating money for home loan, student loan, investments, maybe travel, maybe kids... pretty overwhelming to me. Once we have our loans paid that extra $1500 month can go a long way. Post loans we could turn that 30 year mortgage into a 15 year mortgage (which means lower rate and pay off sooner), or max out retirement accounts, or go on a nice trip twice a year, or have a kid (i know, terrible investment), or maybe all of the above. Point is, there is no "best" way to do it because everyone's situation is different. If you have the opportunity to pay off the loans, pay them off. Seriously... once you get past the whole throwing away 50k bit, it feels great. Even if investment returns are slightly higher than your loan rate... I still think the "return" on paying off loans and having the freedom is worth the extra ~1% you may get on your investment. Just my opinion.
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